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To use or not to use a pacifier: What should parents do?

04/30/12 Portland, Ore.

Many hospitals are removing pacifiers from their newborn units to achieve '"Baby-Friendly" status, but researchers at Oregon Health & Science University Doernbecher Children's Hospital believe more research supporting this recommendation is needed.

After analyzing feeding data on 2,249 infants born between June 2010 and August 2011 in the Mother-Baby Unit, the pediatrician-scientists found routine removal of pacifiers during the birth hospitalization was associated with decreased exclusive breastfeeding and increased supplemental formula feeds.

"There is a great deal of energy, nationally and internationally, in support of increasing the number of 'Baby Friendly' hospitals. Baby-Friendly hospitals and the 10 steps, when taken together, have been shown to increase exclusive breastfeeding, but the effect of pacifier use on the initiation and duration of exclusive breastfeeding has not been well-established," said Laura Kair, M.D., a resident in pediatrics at OHSU Doernbecher Children's Hospital.

OHSU Doernbecher and many other hospitals nationwide have been working to implement The World Health Organization's Baby-Friendly hospital initiative to improve exclusive breastfeeding rates during the birth hospitalization. The Baby Friendly initiative outlines "10 Steps to Successful Breastfeeding," including no routine use of pacifiers.

"We know that breast milk is the best food for newborns, and part of our job as pediatricians is to educate parents about the benefits by promoting exclusive breastfeeding. Pacifiers pose a dilemma for parents and pediatric providers. There is concern pacifiers interfere with breastfeeding, but there is evidence pacifier use reduces the risk of Sudden Infant Death Syndrome. The American Academy of Pediatrics recommends delaying the introduction of pacifiers until three to four weeks when breastfeeding is established," Kair explained.

The Joint Commission, the national accrediting body for hospitals and health systems, has adopted exclusive breastfeeding as one of its core standards for optimal perinatal care and encourages hospitals to measure and report it. The American Academy of Pediatrics also recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for the first year of life and beyond.

In compliance with the Joint Commission and with the intent of improving breastfeeding rates, the OHSU Mother-Baby Unit began measuring types of feedings offered during the birth hospitalization. Kair and her colleague, Carrie Phillipi, M.D., Ph.D., director of the OHSU Mother-Baby Unit, who are working to help OHSU attain Baby Friendly designation, then implemented a policy in December 2010 in the Mother-Baby Unit to stop the routine distribution of pacifiers to breastfeeding newborns.

Pacifiers were placed in a locked supply management system that required clinicians to enter a code, the patient's name and a written reason for checking out a pacifier. Pacifiers were allowed in special circumstances, for example, to dip in sugar solution and offer during a painful procedure. Parents could bring in a pacifier from home if they wished.

Kair and Phillipi retrospectively analyzed data about the feedings offered to 2,249 infants admitted to the OHSU Mother-Baby Unit from June 2010 to August 2011. They found that when pacifiers were still distributed, from July 2010 to November 2010, about 79 percent of the infants in the unit were exclusively breastfed. This percentage decreased significantly to 68 percent after the no-pacifier policy was implemented, from January 2011 to August 2011.

The researchers also found a 10 percent increase in the number of breastfed infants being fed supplemental formula after the no-pacifier policy. The percentage of exclusively formula fed infants did not change.

"Despite the common belief among medical providers and the general public that pacifier use negatively impacts breastfeeding, we found limiting pacifier use in the Mother-Baby Unit was associated with decreased exclusive breastfeeding and increased supplemental formula feeds," explained Kair. "We view this as an interesting observation, but we do not claim a cause and effect relationship. Our goal in publicizing this data is to stimulate dialogue and scientific inquiry into the relationship between pacifiers and breastfeeding. Our overall goal is to increase breastfeeding rates, even in Oregon which already boasts the highest rate in the nation."

About OHSU Doernbecher Children's Hospital

OHSU Doernbecher Children's Hospital ranks among the top children's hospitals in the United States in eight clinical specialties.* It ranks 36th nationally for NIH-awarded pediatric research funding among children's hospitals affiliated with an academic medical center**, and is one of only 22 NIH-designated Child Health Research Centers in the country.

OHSU Doernbecher cares for tens of thousands of children each year from Oregon, southwest Washington and around the nation, resulting in more than 175,000 discharges, surgeries, transports and outpatient visits annually.

Nationally recognized OHSU Doernbecher physicians and nurses provide a full range of pediatric care in the most patient- and family-centered environment. These highly trained clinicians also travel throughout Oregon and southwest Washington, providing specialty care to more than 3,000 children at more than 150 outreach clinics in 15 locations. In addition, OHSU Doernbecher delivers neonatal and pediatric critical care consultation to community hospitals statewide through its state-of-the-art telemedicine network.

* U.S. News Best Children's Hospitals 2011-12
** National Association of Children's Hospitals and Related Institutions

About Pediatric Academic Societies

The Pediatric Academic Societies (PAS) are four individual pediatric organizations that co-sponsor the PAS Annual Meeting – the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics. Members of these organizations are pediatricians and other health care providers who are practicing in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well being of children worldwide. Follow news of the PAS meeting on Twitter.